All-terrain vehicle injury in children: strategies for prevention.

OBJECTIVE: A variety of educational efforts, policies, and regulations have been adopted to reduce all-terrain vehicle (ATV) injury in children. Despite this, ATV use by children continues and serious injuries are common. The purpose of this study was to investigate the knowledge, practices, and beliefs of ATV users to help develop effective educational strategies to promote safer ATV use. DESIGN: Focus groups were conducted to characterize participant ATV use and safety awareness as well as to explore avenues for prevention. Feedback on draft ATV safety public service announcements was elicited. Themes of transcribed focus group data were summarized. SETTING: Rural state with high ATV use and injury rates. SUBJECTS: Adult and adolescent ATV users. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Summaries of focus group discussions. RESULTS: ATV riders frankly discussed current use and safety behaviors and were aware of some ATV risks. Youths felt that age specific regulation was unlikely to be a helpful strategy. Participants endorsed messages demonstrating graphic consequences as likely to get the attention of young riders regarding risks. Educational settings were suggested, including hunter and driver safety classes. CONCLUSIONS: Efforts to improve ATV safety awareness should clearly show pediatric ATV injury risk and safety practices. Campaigns must also show realistic understanding of current use practices to be credible for users. Messages emphasizing the consequences of ATV use were endorsed as most likely to have impact. Approaches based on age based restrictions were considered unrealistic and alternative strategies were suggested.

Clinical effect of a quality assurance system for radiographs in a pediatric emergency department.

The objective of this study was to determine the clinical relevance and effectiveness of a quality assurance system used to identify discordant x-ray interpretations between emergency department pediatricians and pediatric radiologists in the emergency department of a large pediatric hospital. Of 5862 patients who underwent 8174 radiographic studies during a one year period, 286 patients with discordant radiographic diagnoses were identified. The incidence of discordant radiograph interpretation was determined to be 3.5% (286/8174 studies). Of those patients with discordant diagnoses, 11.5% (33/286 discordant diagnoses) received immediate intervention by the emergency department, 64.0% (183) received subsequent intervention at their follow-up appointment or by the inpatient team caring for them, 9.4% (27) required no intervention, and 15.0% (43) had no evidence of necessary intervention documented on their medical record. While only 33/5862 (0.6%) patients receiving radiographs after routine working hours required immediate intervention by the emergency department, this intervention was potentially lifesaving. No adverse outcomes were identified in this group of patients who did not receive immediate interpretation of their radiographs by a radiologist. When 24-hour in-house radiology coverage is not provided, a quality assurance system that recalls patients identified with discordant radiographic diagnoses, who may require a change in management, appears to be an effective method of patient management only when discordant interpretations are identified and promptly acted upon.

Iron/ascorbate-induced lipid peroxidation changes membrane fluidity and muscarinic cholinergic receptor binding in rat frontal cortex.

Lipid peroxidation (LP) is a complex process which involves the formation of lipid free radicals and leads to oxidative damage. LP has also been implicated in several neurodegenerative diseases as well as aging. In the present study, we evaluated the effects of the induction of LP in vitro on muscarinic cholinergic (Mch) receptor binding and membrane fluidity in rat brain. Membranes from the rat frontal cortex were peroxidized by adding ferrous sulphate (84 microM) and ascorbic acid (400 microM). Peroxidation was measured as the amount of thiobarbituric acid reactive products formed (nmol malondialdehyde/mg protein). Mch receptor binding was measured 10, 20 and 30 min after peroxidation. Membrane fluidity was evaluated by fluorescence polarization studies using two probes; 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-[4(trimethylamino)phenyl]-1,3,5-hexatriene (TMA-DPH). Significant alterations in Mch receptor binding (decreased Bmax and increased Kd) were found after peroxidation. Membrane fluidity was also significantly decreased after peroxidation as observed with both probes. The decrease in membrane fluidity was due to an increased cholesterol to phospholipid molar ratio after peroxidation. These data suggest that lipid peroxidation induces changes in membrane dynamics as detected by the fluorescent probes and such changes in membrane microviscosity may be the cause for alterations in Mch receptor kinetics.

cis-1,2,3a,4,5,9b-hexahydro-3H-benz[e]indoles: synthesis and in vitro binding affinity at dopamine D1 and D2 receptors.

cis-1,2,3a,4,5,9b-Hexahydro-3H-benz[e]indoles were synthesized and evaluated for in vitro dopamine D1 and D2 receptor binding affinity. The target compounds 21-25 were readily prepared by reduction of the air-sensitive tricyclic enamines 10-14. Reduction of 10-14 with sodium borohydride, sodium cyanoborohydride, palladium on carbon in ethanol, and platinum oxide in ethanol or acetic acid gave only the cis (3a,9b) 1,2,3a,4,5,9b-hexahydro-3H-benz[e]indoles. The stereochemistry was confirmed by single-crystal X-ray analysis. In the 6-hydroxy series, the binding affinity at D1 and D2 receptors was of the order 22 (N-n-butyl) > 21 (N-n-propyl) > 23 (N-H). The compounds demonstrated greater binding affinity at D2 receptors than at D1 binding sites. In contrast, 8-OH derivatives exhibited affinity only for D2 receptors, with 25 (N-n-butyl) having slightly greater affinity than 24 (N-n-propyl).

Ester and amide prodrugs of ibuprofen and naproxen: synthesis, anti-inflammatory activity, and gastrointestinal toxicity.

Ester and amide prodrugs of ibuprofen (1) and naproxen (16) were synthesized and evaluated for anti-inflammatory activity and gastrointestinal toxicity. The chemical structure of the prodrugs was varied in terms of lipophilicity and reactivity toward hydrolysis. Inhibition of acetic acid-induced writhing in mice indicated that prodrugs 7, 15, 19, and 20 exhibited significantly better activity (p less than 0.01) than the parent compounds. The average number of ulcers formed in the gastric mucosa following oral administration of 1 and 16 and prodrugs 5, 18, 21, and 22 was determined in rats. All prodrugs, except the glycine amide 21, were significantly less irritating to the gastric mucosa than either 1 or 16.

In vivo acetylation of homocholine and beta-methylcholine in rat brain.

A nitrogen phosphorus-gas chromatographic procedure was modified to determine the extent of in vivo acetylation of the choline analogs homocholine and beta-methylcholine. Infusion of homocholine (18 mumoles) for 2 hours into the lateral ventricle of the rat produced 2.3 nmoles/gram of acetylhomocholine which represented 0.035% of the detected homocholine. Infusion of the same quantity of beta-methylcholine produced 1.0 nmole/gram of acetyl-beta-methylcholine representing 0.025% of the detected beta-methylcholine. Although pretreatment with hemicholinium-3 reduced the amount of acetylated product formed from either analog, the reduction was significant only for acetyl-beta-methylcholine (p less than 0.01).